Photo: RNZ / Samuel Rillstone
The Associate Health Minister Casey Costello's "independent advice" on heated tobacco products is five articles that are either about different products, outdated, or only offer weak support for her view.
The five documents are not decisive on the benefits of the products.
They include:
- A 190-page report from Royal College of Physicians in the UK, published in 2016 that does not specifically mention heated tobacco products
- An article from the International Journal of Environmental Research and Public Health (IJERPH) in 2022, suggesting HTPs may help with smoking cessation, but the benefits are reduced if HTPs are used as a replacement for less-harmful vaping, and warns it could encourage non-smokers to use tobacco or lead former smokers to relapse
- A 2016 article (IJERPH) indicating the use of a different tobacco product, Snus, 'appears to facilitate' smoking cessation in Sweden
- A 2020 article (IJERPH) about smoking patterns in Japan - where nicotine vaping is not used - showing cigarette sales decreased after the introduction of Heated Tobacco Products
The final article was a comment piece published in the Lancet.
A more recent report from the Royal College of Physicians also says the tobacco industry's claims heated tobacco products are less harmful than cigarettes is "not yet supported by independent evidence".
The 2022 article also highlights that while substantial research has been devoted to nicotine vaping products, "much less is known about HTPs".
"Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products," it states.
Costello gave preference to this independent advice over a long list of problems Treasury had identified with the proposal to go ahead with a 50 percent excise tax cut for HTPs, at a cost of up to $216 million.
Among the Cabinet papers and advice provided to Costello, a health analyst at Treasury also referred to a review by the Health Ministry of the most up-to-date available research which found "no compelling evidence of any benefit from the use of heated tobacco products".
"The World Health Organisation asserts that claims of HTPs as a smoking cessation aid should not be made. We would also advise caution in highlighting positive outcomes from moving from smoked tobacco to Heated Tobacco Products," the analyst said.
"The aforementioned rapid literature review also noted some evidence of harm from HTPs. This included risks of dependency and addiction, exposure to toxicants, cardiovascular impacts, chronic respiratory disease, and developmental impacts."
On Monday RNZ revealed Treasury officials had told Costello that tobacco company Philip Morris would be the biggest winner from tax cuts for the products, which they said were toxic and more harmful than vaping.
Philip Morris' IQOS device is the only heated tobacco product available in New Zealand.
Users insert sticks of tobacco into the device, which heats the tobacco to a vapour rather than burning it.
Treasury said it was not a given that Philip Morris would pass on the cut to consumers, given it had a monopoly in the market.
"It may be that the reduction in excise taxes is not passed through to consumers in price reductions, but rather is retained by the sole importer," Treasury warned.
Costello initially declined to be interviewed by RNZ or reveal the sources of her independent advice, and did not address specific questions put to her before the story was published.
In a statement, she said: "I have no connections to the tobacco industry and it's completely wrong to suggest that the tobacco industry has anything to do with these policies, which are aimed at helping people quit smoking."
She later agreed to a sitdown interview, telling RNZ on Wednesday she had never claimed heated tobacco products (HTPs) were safe, just that they were less harmful than smoking.
"Health confirmed that it's less harmful than smoking. So what we're talking about is harm reduction products to send people on a pathway to quit smoking.
"What we knew was that heated tobacco as an alternative to smoking was less harmful than smoking, considerably less harmful. But we definitely weren't saying it was safe, or suggesting take that up instead of smoking," Costello said.
Evidence on HTPs still emerging
Costello has repeatedly said the excise tax cut for HTPs is designed to lower smoking rates by offering alternatives for people struggling to quit. She has claimed that "HTPs have a similar risk profile to vapes".
But Treasury's advice to her was that it was "clear that HTPs are more harmful than vaping."
"Emerging research suggests that heated/smokeless tobacco products still produce toxic emissions similar to those in cigarette smoke, and also expose users to some toxicants specific to heated/smokeless products which could also expose bystanders."
Cutting taxes on those products might produce worse health outcomes, Treasury said.
"Removing excise tax from heated tobacco products might see nicotine consumers move away from vaping, which evidence suggests is far less harmful compared to tobacco-based products."
It said it was not even clear they were significantly less harmful than cigarettes.
"Industry claims that because the tobacco is heated rather than burned, HTPs are less harmful. HTPs do contain toxicants at lower levels than cigarettes in some cases, but also contain some toxicants that cigarettes do not."
Both health and Treasury officials have stressed the lack of evidence that HTPs even work as a smoking cessation tool.
The documents said because "HTP use is associated with dual cigarette/HTP use, and is not associated with smoking cessation" there was a risk smokers would continue to use both cigarettes and HTPs.
"Some studies suggest that former smokers that use HTPs are more likely to relapse. Other studies suggest HTP users are less likely to transition away from smoking conventional cigarettes than those users exclusively smoking cigarettes."
HTPs pulled from shelves after being caught by new vape regulations
The snag in Costello's changes, as revealed by RNZ on Wednesday, is Philip Morris has been forced to pull its device from sale.
Despite differing from vapes - which contain nicotine but not tobacco - the IQOS has been caught by Labour's regulations forcing devices to have removable batteries and child safety mechanisms, which kicked in on 1 October.
Documents show Costello tried to have the regulations delayed for two years, but the Cabinet only agreed to a six-month delay from the original date of 21 March.
In her argument for a delay, Costello made reference to difficulties international players in the nicotine industry may face with the regulations.
"It is likely that higher quality vaping devices used by former adult smokers will soon be unavailable domestically as high-end manufacturers that cater to international markets may not make New Zealand specific models," she wrote.
RNZ asked Costello's office if the passage referred to the Philip Morris IQOS device but she did not directly address that question.
"The policy is blind as to whether particular suppliers or retailers are impacted in any way," Costello said in a statement to RNZ.
David Broome, chief of staff for NZ First between 2014 and 2017, is external relations manager at Philip Morris.
Apirana Dawson - who was director of operations and research in the office of Winston Peters between 2013 and 2017 and led the election campaigns for the party in 2014 and 2017 - is Philip Morris' director of external affairs.